That’s bad enough, but no-calorie sweeteners – even stevia – may contain other serious health risks. This article cuts through the complacency and hyperbole to give you the facts.

FDA-Approved No-Calorie Sweeteners

The Food and Drug Administration (FDA) has approved six no-calorie sweeteners as food additives – i.e., they are "generally recognized as safe" (GRAS) when usage is limited to the FDA-specified "acceptable daily intake" (ADI). The approved no-calorie sweeteners are:

• Acesulfame Potassium (Sunnett, Sweet One)
• Aspartame (Equal, NutraSweet)
• Neotame
• Saccharine (SugarTwin, Sweet ‘N Low)
• Stevia extracts Rebaudioside A and Stevioside (Truvia, PureVia, SweetLeaf Stevia)
• Sucralose (Splenda)

FDA approval does not mean zero risk; it just means that the risk was deemed acceptably low. However, mistakes can and do happen. For example, DES had FDA approval for decades and was given to millions of pregnant women before it was found to cause birth defects and approval was withdrawn.

The four no-calorie sweeteners in widespread use in the US today are aspartame, saccharine, sucralose, and stevia extracts, so these are the ones I’ll focus on. Some of the information comes from the Natural Health Sherpa, which has a series of well-referenced articles. They have a point of view, but the articles are thoroughly documented so you can check facts and draw your own conclusions. Other sources are referenced throughout.

I’ll start by debunking a myth: It’s not true that artificial sweeteners trigger an insulin response, and cause weight gain for that reason. They do cause weight gain, but for a different reason.

Aspartame

Aspartame is an artificial sweetener – a chemical. A scientist at the pharmaceutical company G.D. Searle discovered it by accident while working on a new ulcer drug. It’s used in many diet sodas, and sold separately under the brand names Equal and NutraSweet. Aspartame breaks down over time and under high temperatures, conditions that can occur during storage. At minimum this causes it to lose sweetness. Some say the breakdown products are toxic, even carcinogenic. One in particular, phenylalanine, is dangerous to people with the rare genetic condition Phenylketonuria (PKU).

One of aspartame’s main ingredients is an excitotoxin, which can cause headaches, dizziness, anxiety, and depression. No one disputes this. Aspartame also may cause more serious problems, notably brain tumors. This is unclear because testing was inadequate, data was hidden and altered, and the FDA approval process was flawed.

Searle first applied for approval of NutraSweet, their aspartame product, in 1973. It was approved for about a week in 1974, but the approval was quickly frozen when problems surfaced. Scientists from the FDA and an FDA-appointed Public Board of Inquiry blocked approval of aspartame for the next seven years. Donald Rumsfeld, a former member of Congress and Gerald Ford’s Chief of Staff, became president of Searle in 1977. The day after Ronald Reagan’s inauguration in January 1981, Searle reapplied for approval of aspartame. In April 1981, Reagan replaced the previous FDA Commissioner with Arthur Hull Hayes, Jr. Hayes set up a panel of five scientists to review the Public Board of Inquiry’s unanimous ruling against aspartame. On May 18, 1981, three of the five scientists wrote a letter stating they could not approve aspartame because the brain tumor data was "worrisome", and data in a key study appeared to have been altered. Hayes responded by adding a toxicologist to the team so the vote became 3-3. The panel lawyer pressured the panel to quickly come to a positive decision, even circulating an approval recommendation, but the scientists against approval would not budge. On July 18, 1981, Hayes overruled the Public Board of Inquiry himself, and approved aspartame for use in dry goods. Two years later, aspartame also was approved for use in carbonated drinks, and the ADI was increased by nearly 50%. Two weeks after that, Hayes resigned under a cloud, accused of accepting gratuities from FDA-regulated companies.

Saccharine

Saccharine, sold under the brand names Sugar Twin and Sweet ‘N Low, was discovered over 100 years ago by a chemist experimenting with coal tar derivatives. It, too, is an artificial sweetener – a chemical never intended for ingestion – and people have been arguing over its safety since it was discovered. Being that it’s made from coal tar combined with chlorine and ammonia, it wouldn’t seem safe on the face of it, and studies have shown that it causes a variety of cancers. Products containing saccharine had to contain a warning label from 1972-2000 because it caused an aggressive bladder cancer in rats. The warning was removed when it was found that rat urine is different from human urine and interacts with saccharine in unique ways, so the bladder cancer might not occur in people. But then again maybe it does. Also, saccharine can cause other types of cancers, as well as allergic reactions.

In 1997, in response to the National Toxicology Program (NTP) plan to delist saccharin as a carcinogen, the Center for Science in the Public Interest issued a report saying: "It would be highly imprudent for the NTP to delist saccharin. Doing so would give the public a false sense of security, remove any incentive for further testing, and result in greater exposure to this probable carcinogen in tens of millions of people, including children (indeed, fetuses). If saccharin is even a weak carcinogen, this unnecessary additive would pose an intolerable risk to the public. Thus, we urge the NTP on the basis of currently available data to conclude that saccharin is ‘reasonably anticipated to be a human carcinogen’ because there is ‘sufficient’ evidence of carcinogenicity in animals (multiple sites in rats and mice) and ‘limited’ or ‘sufficient’ evidence of carcinogenicity in humans (bladder cancer) and not to delist saccharin, at least until a great deal of further research is conducted." But they delisted it anyway.

Stevia extracts

Stevia was available only as a dietary supplement from 1995 until December 2008, when the FDA finally determined that a highly refined extract of stevia called rebaudioside A is safe for use as a food additive (GRAS). Whole leaf stevia and crude extracts of stevia are still deemed unsafe as additives.

The FDA has approved five sweeteners containing Rebaudioside A. At least two are sweetener blends where Rebaudioside A is not the only ingredient, and may not even be the main ingredient. The Cargill product, called Truvia, is sold by Coca-Cola. It also contains significant amounts of a sugar alcohol called erythritol, and the ever-mysterious "natural flavors". The Merisant subsidiary Whole Earth Sweetener manufactures PureVia for PepsiCo. It also contains dextrose (aka d-glucose, a caloric sweetener), cellulose powder, and "natural flavors".

Shortly after Truvia and PureVia received GRAS approval, Wisdom Natural Brands requested and received GRAS approval for its Sweetleaf Stevia product [PDF], which contains both Rebaudioside A, the sweetest part of stevia, and Stevioside. Stevioside also is sweet, but not as sweet as Rebaudioside A, and can have a bitter aftertaste.

Stevia is viewed as the "good" no-calorie sweetener because it’s derived from a plant and thus "natural". But "natural" is not synonymous with "good for your health". There are plenty of plant-based poisons, plus the label has no legal meaning. Consider this description of a "natural" food from the FDA:

From a food science perspective, it is difficult to define a food product that is ‘natural’ because the food has probably been processed and is no longer the product of the earth. That said, FDA has not developed a definition for use of the term natural or its derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances.

By this definition, high-fructose corn syrup is "natural", though it’s too highly processed to be recognizable as corn, and is very bad for your health – essentially because it’s so highly processed. Stevia-based sweeteners are just as highly processed and unrecognizable as the original plant.

Misleading as it is, the "natural" label has major selling power. Truvia was the second best-selling sweetener in 2011, behind sucralose-based Splenda. Now soft drinks with stevia-based sweeteners are becoming available. That doesn’t make them good for you. As with any other no-calorie sweetener, regular use will slow your metabolism and increase your appetite so you’ll tend to gain weight.

Last but not least, don’t use whole leaf stevia or crude extracts of stevia for significant sweetening on a regular basis. Although this is stevia at its most natural, studies show it may be dangerous. The FDA says, "Among these concerns are control of blood sugar and effects on the reproductive, cardiovascular, and renal systems." The plant world contains many natural toxins.

Sucralose

Sucralose is an artificial sweetener – a chemical – discovered accidentally while creating an insecticide. It’s sold under the brand name Splenda. Sucralose is so intensely sweet – 600 times sweeter than sugar – that Splenda is cut with dextrose (aka d-glucose, a sweetener with calories) so it has some bulk. A cup of Splenda has 96 calories; a serving of one packet has 4 calories. Since 4 calories is "less than 5 calories", it meets the FDA’s standard for "no calorie food".

Sucralose is made by replacing two of the sugar molecules with chlorine, a toxin. Some people experience side effects with sucralose, notably severe headaches and worsened migraines.

Some rats given sucralose showed toxicity, but they were huge amounts, way beyond what a person would eat. Moderate amounts over the short-term seem safe, but there have been virtually no long-term studies. In fact, there are relatively few studies of any kind, and that is the main problem with sucralose. It has been insufficiently studied, so we really don’t know whether it’s safe.

Splenda is by far the number one no-calorie sweetener, with a dominating 42.8% market share in 2011.

Artificial Sweeteners Contaminate Drinking Water

Even if you don’t want to use artificial sweeteners, to some extent you don’t have a choice. Certain artificial sweeteners are widespread in our drinking water.

Wastewater has been found to contain acesulfame, saccharin, sucralose, and cyclamates (cyclamates are still legal in Europe). The body can’t break them down, so they go right through you into the toilet. Wastewater treatment methods sometimes can’t break them down, either. The treatment process removes some saccharin and cyclamate, but no acesulfame and very little sucralose (12%). Studies show that both acesulfame and sucralose are widespread contaminants of groundwater and tap water:

"Acesulfame was consistently detected in untreated and treated wastewater (12−46 μg/L), in most surface waters, in 65% of the investigated groundwater samples, and even in several tap water samples (up to 2.6 μg/L) from Switzerland."

"…water samples from 19 United States (U.S.) drinking water treatment plants (DWTPs) serving more than 28 million people were analyzed… Sucralose was found to be present in source water of 15 out of 19 DWTPs (47–2900 ng/L), finished water of 13 out of 17 DWTPs (49–2400 ng/L) and distribution system water of 8 out of the 12 DWTPs (48–2400 ng/L) tested."

You may think someone should tell the EPA that artificial sweeteners are contaminating our lakes, streams, and drinking water. Sadly, the EPA already knows and is delighted. They love that people drink so much diet soda that wastewater concentrations of artificial sweeteners are higher than for prescription medicines, and never break down. This means that artificial sweeteners can serve as "wastewater tracers", allowing scientists to follow the movement of water from sewage treatment plants into the environment. That lets them detect leaks and possible contamination.

There have been no studies on whether artificial sweeteners harm plants or aquatic life. Sucralose is toxic to dogs, however, and makes humans fat, so hopefully it won’t build up too much in tap water. The water filters on the market today do not remove artificial sweeteners.

Thoughts? Comments? I’d love to hear them.

(1) Sugar Is Toxic: Heart Disease, Cancer & More
(2) Sugar: How Much Is Too Much?
(3) Artificial Sweeteners Make You Fat (3a: Health Risks of No-Calorie Sweeteners)
(4) Sugar: Physical Addiction or Emotional Craving?

People drink diet soda to avoid calories and keep from getting fat. Yet study after study shows that daily use of artificial sweeteners is strongly associated with obesity. Do overweight people tend to drink diet soda, or does diet soda cause people to become overweight?

A number of recent studies make it clear: artificial sweeteners cause obesity. They confuse the body, causing appetite to increase and metabolism to slow. When something tastes like it should have calories but does not, you eat more and get fatter from what you eat. The same effect has been found with fat substitutes.

You can’t get something for nothing. Everything you consume has a cost. It’s ironic that the cost, in this case, is obesity.

Two Longitudinal Studies of Diet Soda

Two large longitudinal studies were recently completed. They showed that people who drank diet soda every day were much more likely to become overweight or obese, and to develop metabolic syndrome and type 2 diabetes. Metabolic syndrome increases the risk of cardiovascular disease and type 2 diabetes, and is associated with obesity.

In August 2008, Sharon P. Fowler and associates published a 9-year longitudinal study, covering 1979-1988, on the relationship between artificially sweetened beverages and obesity. They found that drinking more than 21 diet sodas per week was associated with almost double the risk of being overweight or obese, regardless of the baseline BMI. So even if people didn’t start off fat, if they drank more than 21 diet sodas per week, they were twice as likely to become fat by the end of the study.

In January 2009, Jennifer Nettleton and associates published a 7-year longitudinal study, covering 2000-2007, tracking diet soda consumption, type 2 diabetes, and metabolic syndrome in over 6800 people aged 45-84. Metabolic syndrome was defined using National Cholesterol Education Program Adult Treatment Panel III criteria, which requires at least three of the following:

• Central obesity: waist circumference > 40 inches (male), > 35 inches (female)
• Triglycerides ≥ 150 mg/dl
• HDL Cholesterol < 40 mg/dL (male), < 50 mg/dL (female)
• Blood pressure ≥ 130/85 mmHg (or treated with medication)
• Fasting plasma glucose (blood sugar) ≥ 110 mg/dl (or treated with medication)

Those consuming 1 or more diet sodas per day had a 36% higher risk of metabolic syndrome than non-consumers, and a 67% higher risk of type 2 diabetes. This wasn’t due to a particular artificial sweetener since the artificial sweetener used changed over the 7-year period.

These longitudinal studies strongly suggest that artificial sweeteners cause obesity, but only controlled lab studies can offer proof. Finally we have this.

Artificial Sweeteners Confuse the Body

Susan Swithers and Terry Davidson, psychologists at Purdue University, have done a series of controlled studies that show that animals (like rats and humans) appear to use sweet taste to predict the caloric contents of food. Eating sweet noncaloric substances degrades this predictive relationship, leading to increased food intake and lowered metabolism.

In a 2008 study [PDF], some rats were given yogurt sweetened with saccharin, and some were given yogurt sweetened with glucose. Those given the artificially sweetened yogurt ate more food, gained more weight, and gained more body fat. Two changes accounted for this:

1. Their caloric compensation ability was reduced. That is, they were less able to adjust for excess calories by reducing intake at a later time.
2. They showed a "blunted thermic response" to sweet-tasting diets. When you are about to eat, the look and the smell of the food causes your metabolism to speed up, and this is measurable as an increase in body temperature – the "thermic response". When the rats used to artificial sweeteners ate sweet foods, their metabolisms didn’t rev up as much. The artificial sweeteners had taught the rats that sweet foods have no calories, so eating naturally sweetened food caused greater than normal weight gain.

These results were reproduced and extended in a 2009 study. In addition to saccharine and low-fat yogurt, the rats were given acesulfame potassium as the artificial sweetener and refried beans as the food. The researchers chose refried beans because they have about the same calories as low-fat yogurt, but a different nutritional profile. The previous results held, plus the researchers found that the effects were resistant to reversal. The rats given the artificial sweeteners continued to gain weight after the artificial sweetener was withdrawn.

Note that weight gain would be expected with any no-calorie sweetener used daily, even a natural one like stevia. Stevia doesn’t have the chemical risks of an artificial sweetener, but it confuses the body in the same way. Coca Cola markets a stevia-based sweetener called Truvia, and PepsiCo markets one called PureVia. They are both starting to use them in soft drinks. Beware. They will make you just as fat as artificial sweeteners, despite being more natural. (Neither is completely natural; both contain other ingredients.)

This unexpected effect of no-calorie sweeteners is probably the answer to another mystery. Generally people lose weight quickly on low-carb diets (if they can stick to them), but occasionally they don’t lose weight at all. I suspect that when they don’t, it’s because they’re using no-calorie sweeteners on a daily basis.

On the plus side, it appears that low-carb diets are more restrictive than they need to be. With the new research on fructose, there is speculation that low-carb diets only work because they reduce added sugar. Starch breaks down only to glucose, and so should not harm health or cause obesity – especially not starch that contains the original fiber, such as whole grain. This is Robert Lustig’s view [VIDEO], and for what it’s worth (sample of 1), it’s my experience. I gain weight from sugar, but not from starch. (Note that commercial bread contains sugar – if you want sugar-free bread, you’ll need to start baking.)

Try to Wean Yourself Off Sweetened Beverages

One of the most unfortunate habits you can get into is drinking sweetened beverages in place of water. Studies show that the body doesn’t know how to compensate for liquid calories. If you drink 600 calories of sweetened beverages, you don’t then eat less food. The body seems to assume that liquid intake is water and calorie-free. Also, as we saw in Part 1, sugared beverages are especially fattening – even more so than solid desserts – because they hit the liver so quickly.

Fruit juice is not a healthy alternative. As a beverage, it’s as bad for you as sugared soda. When you mix it with tea or seltzer, it’s no different from adding sugar. See Part 1 for why.

Unfortunately, artificially sweetened beverages are not a solution because they make you gain weight for a different reason.

There really is no way that you can get away with a sweetened beverage habit without gaining weight. So if you’d like to lose weight without dieting, weaning yourself off sweetened beverages is a surprisingly effective way to do it. It’s one of the single healthiest changes you can make to your eating habits. Sweetened beverages are just a habit – you can do this. It’s in your DNA to like water. I mainly drink water or seltzer, and I prefer unsweetened tea and coffee. I drink herbal tea plain, and put milk in black tea or coffee to break the acid. You might think you couldn’t possibly get used to this, but you can, and I really encourage you to try.

In the final article in this series, Part 4, I’ll talk about sugar addiction – why going without sugar for even a day (or giving up sweetened beverages) can feel so impossible. Are the cravings physical, emotional, or both, and how do you break free?

Thoughts? Comments? I’d love to hear them.

(1) Sugar Is Toxic: Heart Disease, Cancer & More
(2) Sugar: How Much Is Too Much?
(3) Artificial Sweeteners Make You Fat (3a: Health Risks of No-Calorie Sweeteners)
(4) Sugar: Physical Addiction or Emotional Craving?

In Part 1 of this series, I described how sugar is implicated in a wide range of illnesses, from heart disease to cancer, as well as causing obesity. Many scientists researching the relationship between sugar and disease have stopped eating sugar as a result of their findings. But is it necessary for health to stop completely?

And is it necessary to eat for health? Sugar does pose a serious threat. But just because a food is unhealthy doesn’t mean you shouldn’t eat it, or that it’s wrong or bad to eat it. What you eat is not a moral issue, there are other considerations besides health, and it’s your life. There’s a big fallacy in the non-diet world that there are “no bad foods” and that is why you can eat all foods. I say something very different: There are bad foods, but you are still entitled to eat whatever you want – just do it with your eyes open. If you deny that some foods are bad for your health, then you can’t take responsibility for your choices.

The purpose of this article is not to tell you what you "should" eat. It’s to give you information that you can use as input for your own decision.

Epidemiological Evidence

As I mentioned in Part 1, one of the diseases that sugar exacerbates, if not causes, is cancer. Researchers believe that as many as 80% of human cancers are driven by elevated insulin levels.

Until the 1700s, sugar was a luxury and very expensive, so only the wealthy ate it, and even they ate it rarely. During the 1700s, sugar started to become popular. The price of sugar initially dropped due to slavery in the Carribbean, and then dropped more during the industrial revolution as sugar production became increasingly mechanized. By the mid-1800s, per capita consumption had skyrocketed in urban areas. Sugar was considered a necessity and a staple of the Western diet.

Something else started happening in urban areas of Europe in the mid-1800s, especially France and England: Cancer rates started rising. The increase was dramatic enough to prompt a survey of cancer rates worldwide to discover the cause. Data from remote locations came from missionaries. If you want to see why they were so upset, take a look at these very graphic photos from the 1800s (don’t look if you’re squeamish – medicine was still quite primitive back then). The researchers discovered that cancer – plus a cluster of other diseases – was extremely rare in isolated populations eating traditional diets. But when these populations started eating a Western diet, all those previously unknown “diseases of civilization” started to emerge: cancer, cardiovascular disease, obesity, dental cavities, periodontal disease, appendicitis, varicose veins, hemorrhoids, and constipation.

It would be instructive to know exactly how much sugar Europeans were eating in the mid-1800s, since it was apparently just past the threshold of what causes disease. In England, it was about 36 pounds per year. Here’s a graph showing sugar prices and consumption in England from 1600-1850.

At this time, sugar consumption in America lagged a little behind Europe at 25-30 pounds per year, and cancer accounted for about 1% of all deaths (PPT). Today, Americans consume more sugar per capita than Europeans – over 100 pounds per year in 2005 – and about 23% of all deaths are due to cancer. (The number often quoted from the USDA [PDF], 142 pounds of sugar in 2005, is unadjusted for cooking losses, plate waste, and other losses. The graph below is adjusted.)

Stephan Guyenet, who compiled these numbers, writes: "It’s a remarkably straight line, increasing steadily from 6.3 pounds per person per year in 1822 to a maximum of 107.7 lb/person/year in 1999. Wrap your brain around this: in 1822, we ate the amount of added sugar in one 12 ounce can of soda every five days, while today we eat that much sugar every seven hours."

Just based on this epidemiological data, we should be eating under 30 pounds of sugar per year, and that is not very much sugar. There are 1760 calories in a pound of sugar. If you eat 30 pounds in a year, that means 145 calories of added sugar per day – less than the calories in one can of soda.

The American Heart Association Recommendation

In the 1970s, there was a debate over whether heart disease was caused by sugar in the diet or saturated fat, with John Yudkin leading the argument for sugar and Ancel Keys leading the argument for fat. Ancel Keys won on political grounds, but he was wrong. Since then, many scientists have found fault with Keys’ methods, countless studies have confirmed the relationship between heart disease and sugar, and in 2009 the American Heart Association (AHA) issued its first ever guideline for added sugar intake.

It turns out that 145 calories of added sugar per day is remarkably close to the AHA recommendation, though they arrive at the number differently. The AHA recommends a maximum of 150 calories per day in added sugar for men and 100 calories per day for women – half the discretionary calorie allowance, according to 2005 US Dietary Guidelines.

You may be wondering if it’s really necessary to cut back this much. Kimber Stanhope, one of the researchers interviewed in the 60 Minutes story on sugar toxicity, wondered, too. She studies the effect of fructose on triglycerides and LDL cholesterol, two risk factors for cardiovascular disease. In a study published August 17, 2011 in the Journal of Clinical Endocrinology and Metabolism, she tested the new stringent guideline against the Dietary Guidelines for Americans from 2010, which says sugar can safely be a maximum of 25% of energy requirements (calories).

She had 48 test subjects, took baseline blood work, and then for two weeks fed them beverages sweetened with either glucose, fructose, or high fructose corn syrup (HFCS). In just that short amount of time, she saw increased triglycerides and LDL cholesterol in the 25% energy group fed fructose or HFCS, but not glucose. If the person is eating 2000 calories a day, that’s 500 calories of sugar – about 2.5 cans of soda per day. When Sanjay Gupta of 60 Minutes asked Stanhope if the results surprised her, she said, “I would have to say I was surprised because when I saw our data, I started drinking and eating a whole lot less sugar. I would say our data surprised me.”

Guidelines for Staying Healthy

Figuring out how to follow the AHA recommendation is tricky. Added sugar is in almost every processed and prepared food – not just sweet beverages and desserts. In 1972, when John Yudkin wrote Sweet and Dangerous, the proportion of sugar eaten in the US that came from manufactured foods was "more than 70%", up from 50% in 1957. I don’t know how he found this number, but it’s probably even higher now. Sugar is in mayonnaise, peanut butter, and bread. Virtually all canned, frozen, packaged, processed, and convenience foods contains sugar. If you eat a lot of these foods, even without sweetened beverages, juice, or sweets, you probably eat significant sugar.

Compounding the calculation difficulty is this: You only need to avoid added sugars – natural sugars are not a problem – but US food labels don’t distinguish between natural sugars and added sugars. So counting your 100 or 150 calories of daily added sugar is virtually impossible, even if you read every label. A more practical approach is to follow some guidelines:

• Drink water, seltzer, or unsweetened herbal tea if you’re thirsty. Avoid soda, juice, and sports drinks. Also remember that alcohol is sugar. Sugar in liquid form is most harmful because it hits the liver quickest.
• Read the label of every packaged food you buy, and avoid brands with added sugar. You can find peanut butter without added sugar if you look.
• Eat less processed and convenience foods – cook at home more. For example, virtually all store-bought mayonnaise and bread contain sugar, but these are easy to make at home, and taste better, too.
• Think of dessert as something you eat once in a while rather than every day. How often? This is probably not the only added sugar you’re eating, so overestimate the sugar calories by assuming that all the carbohydrate calories are from sugar. If you’re a woman and the dessert contains 300 calories from carbohydrates, figure you’re eating three days worth of sugar.
• Don’t use artificial sweeteners. They cause obesity in a different way, as you’ll see in Part 3 of this series.

If you’re reading this and thinking “No way!”, here are some thoughts for you:

• If you’re currently eating sugar once a day or more, you may be physically addicted. Once the physical addiction is broken, it won’t seem so impossible to cut down. I’ll address this in Part 4.
• Don’t let the perfect be the enemy of the good. If you’re eating less sugar than you were, you are still better off.
• It’s not like you can never taste sweetness again. Fruit is delicious!
• It’s your right to continue eating sugar as you have been, but doing so should mean you accept the risks to health and weight, not that you are denying these risks.

Not every food decision is made on the basis of health and what will extend life – or should be. Not every life decision is made on the basis of what will extend life. Quality of life matters, too. If all we cared about was living as long as possible, we’d live in a sterile bubble and never get in a car or do anything. People take risks to make life worth living.

You may decide that eating some amount of sugar is worth the risk. Or you may decide it’s not worth the risk. Either way, these are the facts. The decision is up to you.

Thoughts? Comments? I’d love to hear them.

(1) Sugar Is Toxic: Heart Disease, Cancer & More
(2) Sugar: How Much Is Too Much?
(3) Artificial Sweeteners Make You Fat (3a: Health Risks of No-Calorie Sweeteners)
(4) Sugar: Physical Addiction or Emotional Craving?

New research shows that sugar is a direct cause of heart disease, diabetes, cancer, and many other diseases, as well as obesity. It’s not that the empty calories in sugar cause obesity, and then obesity indirectly causes these diseases. Sugar causes obesity in ways far more insidious than empty calories, and it causes these diseases directly – not indirectly through obesity. Sugar is a toxin – a "chronic" toxin in that damage takes many exposures. I love sugar as much as anyone, so I didn’t want this to be true, but there’s no doubt that it is.

There’s another serious problem with sugar for anyone using the non-diet approach. Sugar seriously interferes with your body’s hunger and satiation signals in multiple ways. When you eat sugar, you never get the "off" signal.

How much sugar can you safely eat? I’ll talk about that in Part 2. Artificial sweeteners are not a way around the problem. In Part 3, I’ll describe the evidence that artificial sweeteners cause obesity through a different mechanism. Part 4 will talk about the addictive aspects of sugar – both physical and emotional – and how to deal with it.

Different Types of Sugar

Table sugar, or "sucrose", is comprised of two simple sugars bonded together: 50% fructose, 50% glucose. Raw sugar has the same composition; there is no benefit. Brown sugar is just sucrose with molasses – same basic composition.

Glucose, or "blood sugar", is the sugar that circulates in your blood. Fructose, or "fruit sugar", is found in plants and honey. It’s the fructose in sugar that causes the problem, as you will see. That doesn’t mean you shouldn’t eat whole fruit; whole fruit contains fiber that slows digestion. It does mean that fruit juice poses a danger. Fruit juice, a processed food, is as dangerous to health as soda.

Generally it’s added sugar that’s the danger – or juice, because it’s been processed to remove the fiber.

High Fructose Corn Syrup (HFCS) has been vilified, but actually it’s only slightly higher in fructose than table sugar: 55% fructose, 45% glucose. The difference is trivial. They’re equally bad for you. The sugar in unsweetened apple juice, however, is 71% fructose – much higher. Plus there is more sugar per ounce in unsweetened apple juice than in Coca Cola. This is true for most other fruit juices, as well.

Worse of all is agave syrup (sometimes called "agave nectar", though it’s made from the root of the plant, not the sap). The internet echo chamber says that agave syrup is 55-90% fructose or 70-97% fructose, depending on the brand. A researcher writing for the Weston Price Foundation actually tested samples from the two manufacturers that make virtually all the agave syrup in the US. He found that agave syrup is 70-85% fructose, with the other 15-30% being glucose.

The Weston Price article gives the nutrient breakdown of two other sweeteners it tested. The sugar in raw honey was 55% fructose and 45% glucose, or about the same as HFCS, and for maple syrup it was 49% fructose and 51% glucose, or about the same as sucrose. So these sweeteners are no better for you. (Both raw honey and maple syrup also contain some water: 17% for honey, 32% for maple syrup. Agave syrup contains no water.)

Sugar: The Bitter Truth

When you eat sweeteners such as sugar, HFCS, honey, or maple syrup, your body breaks them down into their component simple sugars, glucose and fructose. These are metabolized by your body very differently. The difference is why fructose is toxic and glucose is not.

My overview of sugar metabolism is largely based on a 2009 lecture called Sugar: The Bitter Truth [VIDEO] by Dr. Robert Lustig, a pediatric endocrinologist. This video has gone viral; it’s been viewed on YouTube more than 2.4 million times (twice by me – it’s rather dense). Here’s a link to the slides from the presentation [PDF] (most of them, anyway). They are hard to read in the video.

The video is 1.5 hours long and starts with a friendly and accessible introduction to the history of sugar, HFCS, and their association with disease (it’s worth watching just for that). Then, speaking very quickly, Lustig goes into excruciating detail on the biochemistry of glucose, ethanol, and fructose metabolism, and why fructose does essentially the same damage to the body as alcohol (ethanol) – "beer belly", fatty liver, etc. If you aren’t already versed in biochemistry, it’s hard to follow. However, I found an almost word-for-word summary on the Mercola site.

The only part of Mercola’s post that doesn’t come from Lustig’s lecture is the recommendation at the end to eat raw sugar or honey in moderation. Lustig would never say that. (1) The sugar in honey is 55% fructose, the same as HFCS, and (2) Raw and refined sugar are the same food, which Lustig knows. He recommends John Yudkin’s book, Pure, White, and Deadly, in his lecture (the US edition is titled Sweet and Dangerous), and Yudkin goes on and on about this, describing sugar processing in detail. (I was lucky enough to find an affordable copy of Yudkin’s hard-to-find book.) I’ll talk about Lustig’s recommendations for how much sugar is safe in Part 2 of this series.

Sugar Metabolism: Disease & Appetite Run Wild

Sugar is 50% glucose, 50% fructose. So every time you eat sugar, you get a substantial hit of fructose. Unless you’re eating glucose in a refined form all day long, it won’t hurt you. But fructose will. Here are the important ways in which glucose and fructose metabolism differ:

Glucose Metabolism
• 80% metabolized throughout the body, 20% metabolized in the liver – little strain on liver.
• Only 0.4% of glucose calories are metabolized in the liver as VLDL (bad cholesterol).
• Raises blood sugar, causing secretion of insulin, causing secretion of leptin (appetite control hormone) – you get the “I’m full” signal.
• Suppresses ghrelin, a hormone that gives a feeling of hunger – you stop feeling hungry.

Fructose Metabolism
• 100% metabolized in the liver – big strain on the liver.
• Produces uric acid as a waste product – excess uric acid causes gout.
• Uric acid blocks the enzyme that makes nitric oxide, which keeps blood pressure low – causes hypertension.
• Increases fat synthesis – causes obesity. One study found 30% of fructose was stored as fat, versus 0.5% of glucose.
• Increases VLDL and triglycerides – risk markers for cardiovascular disease.
• Transport of VLDL to adipose sites causes insulin resistance (it takes more and more insulin to remove glucose from blood) leading to type 2 diabetes.
• Insulin resistance causes hyperglycemia, leading to organ and nerve damage.
• Insulin resistance causes elevated insulin, leading to heart disease and cancer.
• Raised triglycerides prevent leptin from crossing the blood-brain barrier so you don’t get the “I’m full” signal, plus elevated insulin makes you always feel hungry.
• Fails to suppress ghrelin – you feel hungry all the time.

Basically, fructose causes Metabolic Syndrome, which consists of three of the following: expanding waist, high triglycerides, low HDL, high blood pressure, high fasting glucose. Metabolic syndrome is a risk factor for cardiovascular disease and diabetes.

Fructose also interferes with appetite control in multiple ways. When you eat sugar, you can’t trust your hunger signals to tell you when you are hungry and full. This is a huge problem – especially if you are trying to eat according to body wisdom.

This damaging scenario is most likely to happen when large amounts of fructose hit the liver quickly. This happens with any food with added sugars, but it happens most quickly when you take sugar in liquid form as a sweetened beverage, or when you eat sweet foods on an empty stomach.

Lustig says that exercise can help, not because it burns off calories, but because it speeds up your metabolism. This can allow you to burn off the fructose before it gets to the fat creation part of the metabolic process. But presumably, there are limits – begging the question, how much is safe to eat? This is the topic of Part 2.

Sugar & Cancer, Sugar & Ulcers

Cancer researchers have discovered that elevated insulin, along with a related hormone called "insulin-like growth factor", promote tumor growth and may even cause cancer. Lewis Cantley, a researcher from Harvard, says that perhaps 80% of all human cancers are driven by high levels of insulin. Craig Thompson, a researcher at Memorial Sloan-Kettering Cancer Center in New York, thinks that many pre-cancerous cells would not become malignant tumors if not driven by insulin to take up and metabolize more blood sugar.

Both Thompson and Cantley told Gary Taubes that they eat as little sugar as possible due to the cancer risk. Cantley said the same thing to 60 Minutes’ Sanjay Gupta: He advised that people not eat sugar or at least keep it to a minimum, adding, "In fact, I live my life that way. I rarely eat sugar."

Yudkin mentions other diseases associated with sugar, based on his own research. For example, eating a lot of sugar appears to cause gastric and duodenal ulcers. He found both epidemiological and experimental evidence. He put young men on a high sugar diet for two weeks, then got them to swallow a gastric tube first thing in the morning. He found that their gastric juices were 20% more acidic and their enzyme activity increased three-fold, both at rest and after a mild meal. This is what causes ulcers. He also did experiments that confirmed that low-sugar diets improved the symptoms of ulcer patients.

Yudkin found evidence for virtually all of the now-verified associations between sugar and disease – heart disease, gout, cancer, and more. Unfortunately no one listened to him back in 1972. The country went with Ancel Keys and his competing "saturated fat" hypothesis as the cause of heart disease. We reduced saturated fats and increased carbohydrates, and heart disease and obesity skyrocketed.

There’s no doubt now that sugar causes heart disease, cancer, obesity, and more. But do we have to stop eating it entirely to stay healthy and slim? How much sugar is safe to eat, and how much is too much? This is the question I’ll address in Part 2.

Thoughts? Comments? I’d love to hear them.

(1) How Habits Can Control Your Eating
(2) 3 Proven Strategies for Breaking Habits
(3) 2 Key Principles in Creating New Habits

Habits are automatic behavior cued by context (where you are, what you’re doing), performed without intention, and with minimal thought. In Part 1 of this series I described how they’re created and why. In Part 2, I described three strategies for blocking or interrupting habits that have already been cued. In this third and last article in the series, I will describe the most effective way to break a habit – avoiding the cue – and how to create new, positive habits.

There are thousands of blog posts about how to break habits and create new ones. My advice will be a little different. As with the previous articles in this series, the strategies I recommend are based on controlled studies written by psychologists and published in refereed professional journals.

Avoid Habit Cues – Take Advantage of Transitions

Hands down, experts agree that the best way to break a habit is to avoid the contexts that cue the habit. There is also consensus that the most effective way to do this (some say the only way) is through major life change: moving to a new town, entering college, graduating from college, changing jobs, getting married, getting divorced, having a baby, etc.

During these natural life transitions, cues are gone, you stop acting out of habit, and you think about everything you do rather than acting automatically. Everything is open to reevaluation. You try new things and decide what you like and don’t like. You meet new people, make new friends.

Retailers love people in transition because they are the most open to trying new brands and products. To identify them, they buy lists, or hire statisticians to create multivariate models. And then they shower them with advertising in the hope that they will establish a new habit that includes heavy shopping at their store.

A time when you have no habits is a time when you are creating new habits. No one knows this better than retailers, but you should know it, too. If you are aware that you are establishing new habits, you can act deliberately and not squander the opportunity. You have a choice: will you create good habits or bad habits?

Take, for example, the transition of marriage. Both men and women tend to gain weight in the first two years of marriage, with women gaining more. New habits are established with marriage, and apparently they typically involve eating more. It’s hard to say what new habits cause the weight gain without more information. But if you thought about what you were eating as a newlywed in terms of new habits, you probably could identify the bad habits and avoid them.

This same principle goes for other transitions. When you become a parent, for example, you don’t have to create a new habit of eating your child’s leftovers. Life changes drastically when a child is born. Be especially careful at times like these not to fall into bad habits that will plague you long term.

If your life isn’t in transition, it’s not as easy to avoid cues. But there still can be opportunities. Look around you and think about your patterns. Here’s a common one. Remove snack foods from counter tops. Just seeing cookies and crackers is a cue for many people. When they are in view, you take a handful. When they are in a cabinet, you don’t.

In Part 2 I talked about how to block habits after they were cued – for example, how to sit in front of the TV without mindlessly eating. It’s much easier without the cue. If you have a habit of eating in front of the TV, watch less TV. If you have a habit of eating while surfing the internet, find something else to do. Take a walk, call a friend, or clean out your closet.

They have a saying in AA: "Don’t go to a barber shop if you don’t want a hair cut." Newly sober people are strongly urged to avoid the places where they used to drink and the people they used to drink with – their habit cues. AA doesn’t teach newly sober people how to go to a bar and not drink. They say, "Don’t go to bars!"

Tip: The easiest way to break old habits is to avoid the contexts that cue them. Use transitions to your benefit.

Create Positive New Habits

How do you create a habit? It’s not just repetition, as many people think. It’s been said that if you do something every day for 30 days it will become a habit. That’s not necessarily so. Here’s why.

Habits are learned as people pursue goals in their daily lives. In the learning phase, the "habit loop" has three parts: a stable context, a routine, and a reward. The loop must repeat many times before it’s stored in habit memory. In a naturally created habit, the reward causes you to repeat the loop – i.e. the routine is very rewarding. Over time, the context becomes associated with the routine. Once the routine becomes a habit, the reward becomes irrelevant and the routine is cued only by the context (see the popcorn study in Part 2). But the reward is a crucial part of habit formation.

There must be a strong and consistent sense of reward for a behavior you’re repeating to be stored in habit memory. This is because storage in habit memory requires dopamine, a neurotransmitter that helps control the brain’s reward and pleasure centers. If the routine doesn’t feel rewarding to you, if it’s not pleasurable on some level, it will never become a habit. Nothing you do over and over while hating every second of it will ever become a habit.

I discovered this in my own life – the hard way. Some years ago, I decided that I would develop a habit of jogging every morning. I’ve never liked jogging because my aerobic capacity has always been limited, even as a child, despite being a normal weight and getting regular exercise. I’ve since learned that aerobic capacity is genetically determined and you can’t improve it beyond a narrow range. But I didn’t know that at the time and I thought I could improve.

Every morning for three months I got up and jogged (as best I could) for two miles. I never improved, and I absolutely hated it. The feeling of insufficient oxygen in my body was agony. After three months I decided I was done with that, and never looked back. No habit was created, despite many repetitions, because I found the behavior completely unrewarding. There was very little dopamine in my brain after jogging.

If you want to establish a new habit, don’t suffer through something for 30 days with the idea that it will magically stick. It won’t. If you want to make a new habit of daily exercise or healthy eating, then you need to find a way to do it that’s fun for you and fits your lifestyle. That is the piece that is missing from most articles about creating new habits. I’ve seen a lot of focus on tricks for making you repeat the new behavior. That’s okay, but if the behavior is intrinsically rewarding, it won’t be that hard to get yourself to repeat it. If it’s not intrinsically rewarding, you can repeat it forever and it won’t become a habit.

Tip: If a behavior is not rewarding, it will never become a habit, no matter how often it’s repeated.

This is the third and last article in the series on Habit Eating. I hope it was useful!

Thoughts? Comments? I’d love to hear them.

(1) How Habits Can Control Your Eating
(2) 3 Proven Strategies for Breaking Habits
(3) 2 Key Principles in Creating New Habits

In Part 1 of this series, I described what habits are, how they are created, and how you can tell the difference between emotional eating and habit eating. It takes many rewarded repetitions for a habit to be created and that’s good, because once habits are created they are extremely hard to break. Habits are automatic behavior cued by context (where you are, what you’re doing), performed without intention, and with minimal thought. When performing a habit your mind is not engaged, and that’s a huge obstacle to change. Resolving to do better, an effective strategy for non-habits, doesn’t help with habits, though thousands of blog posts offer this type of advice.

In researching this article, I read controlled studies written by psychologists and published in refereed professional journals to find out what really works. There are two general strategies: (1) avoid the context that cues the habit routine, or (2) block or interrupt the habit routine after it’s been cued. Avoiding cues is most effective, but not always practical. I’ll talk about that in Part 3 since it’s related to creating new habits. In this article I’ll describe three strategies for blocking or interrupting habit routines after they’ve been cued.

From Automatic Action to Intentional Control

What makes habit eating so difficult to manage is that it’s performed automatically, without goals or intentions. Eating is cued by context, regardless of hunger level or the taste of the food. A pair of studies by Neal, Wood, Wu and Kurlander demonstrated the problem, and found an interesting way around it. It was published in the Personality and Social Psychology Bulletin in 2011: The Pull of the Past : When Do Habits Persist Despite Conflict With Motives? [PDF].

They found that people with a strong habit of eating popcorn at movies would eat the same amount of popcorn, whether freshly made or 7-days old and stale, if cued by the context of a movie theatre. The data analysis showed that they ate regardless of hunger and taste – strictly out of habit. People with a weak movie popcorn habit ate much less of the stale popcorn in the movie theatre. And people with a strong movie popcorn habit ate much less of the stale popcorn if they were watching videos in a conference room – the cue of "movie in a movie theatre" was missing.

The question then became, is there a way to stop a person with a strong movie popcorn habit from eating popcorn at the movies? If making the popcorn taste bad doesn’t help, can anything help? The researchers found that a very simple manipulation was surprisingly effective: eating with the non-dominant hand. When right-handed people ate with their left hands and left-handed people ate with their right hands, it didn’t matter how strong their movie popcorn habit was. They ate much less of the stale popcorn in the movie theatre. Using the non-dominant hand took the popcorn eating behavior out of automatic control and put it back into into intentional control. That is, the person’s eating could again be governed by goals such as satisfying hunger, avoiding overfullness, and enjoying the taste of the food.

The non-dominant hand strategy is interesting because it operates without any effort on the part of the person doing the eating (beyond using the non-dominant hand). The subjects in the study didn’t even realize that their popcorn eating behavior was being observed. They thought the study was about personality differences in movie interests. The subjects with a strong movie popcorn habit didn’t know they’d been assessed in this manner (the popcorn eating questions were buried among unrelated questions), and had no idea that eating with their non-dominant hand affected how much they ate. They ate less effortlessly. Without any awareness on their part, their behavior became intentional rather than automatic, and that allowed them to respond in a goal-directed way to the bad taste in their mouth.

Tip: Next time you find yourself snacking in front of the TV (habit cue: TV), eat with your non-dominant hand.

Vigilant Monitoring and Willpower

The usual strategies for behavior change simply don’t work with strong habits. Education and information can change non-habits, but not habits. Study after study has found that strong habits override the best intentions. If you teach principles of nutrition to a person with a strong junk food habit, you just get an educated junk food eater.

Until the popcorn study was done, the only strategy found to be even somewhat effective in stopping cued habit routines was vigilant monitoring and willpower – noticing your impulses and thinking, "Don’t do it!" (Of course, the non-dominant hand technique won’t help with all habits, just habit eating.)

Vigilance and willpower only work as a short term strategy. Over the long term, it’s too tiring and can backfire (as with diets). But a short-term strategy can be useful; it can buy you time.

The other limitation is that vigilance and willpower only work with weak habits. If the habit you want to break is strong, however, there may be a way to weaken its pull. I’ll discuss that next.

Tip: With willpower you can block bad habits long enough to replace old routines with new ones – if you weaken the pull of the habit first.

Weaken Habits with Self-Care

Let’s say you have a habit of stopping at a fast food restaurant for dinner on your way home from work. You know the food isn’t healthy and it doesn’t even taste that good, but when you see the restaurant on your way home, you always stop. Then afterwards, you wish you hadn’t eaten it. Perhaps if you didn’t see the restaurant you wouldn’t be cued, but you can’t get home without driving past it. How do you break this habit?

Remember that the purpose of habit – the reason you have this skill – is to allow you to perform tasks automatically while your brain is free to think about other things (see Part 1). Habits are efficient. They are always your quickest, easiest, and most effortless option. They require no thought. Anything you do instead will take more effort. The outcome of a new behavior may be more rewarding, but the effort of non-automatic action is a an anti-reward and a barrier – especially if you are overtired, under time pressure, or already worn out from pushing yourself. This state of mind magnifies the impact of habit. You may long for a healthy home-cooked meal, but if you haven’t shopped and you’re pressured for time, the fast food habit will win out.

If you want to improve your chances of making it past the fast food restaurant, get adequate sleep, and shop in advance so you can put a meal together quickly after arriving home. Are you reading this and thinking, "I don’t have time to sleep, shop, or cook"? If so, then you need to make some adjustments in your life. Make time for self-care!

I can’t tell you how often new members in the Normal Eating Forum post that they don’t have time to take care of themselves – they have too many things to do, too many other people who need them. They don’t realize that this is exactly why they are emotional eaters. Instead of honoring and attending to their basic human needs, they make do with food band-aids. Self-care is the first responsibility of every adult. Model it for your children!

Tip: Self-care makes you strong. Self-care gives you options.

The third and last article in this series will discuss the most effective habit-breaking strategy of all: avoiding the contexts that cue your habits. It’s not always practical, as I’ll explain, but if you’re in a position to do this, don’t lose the opportunity. Finally, I’ll discuss how to create new and better habits – not anecdotally, but based on the science.

Thoughts? Comments? I’d love to hear them.

(1) How Habits Can Control Your Eating
(2) 3 Proven Strategies for Breaking Habits
(3) 2 Key Principles in Creating New Habits

Sometimes you eat because you’re hungry and the food tastes good. But often you eat because it’s noon and you always eat at noon. Or you just got home and you always eat when you first get home. You may not be hungry and the food may not be tasty, but you eat it anyway. Then afterwards you think, "Why did I eat that? Next time I won’t!" But next time, you do it again.

This is habit eating. Habits are overlearned behaviors that are cued by something in your environment (for example, time of day or just arriving home), and performed automatically with little attention or thought. Habits are not goal-directed – you’re not eating to satisfy hunger or experience taste. So why are you eating??

The Science of Habit

I started thinking about habit eating when I came across an article in the New York Times on the science behind shopping habits. There was a brief mention towards the end about habit eating. The article had no references and mentioned only one scientist’s name, but I found the original studies through internet searches. (There are some inaccuracies in this article, so read it with caution. For example, he says that reward is part of an established habit and this is untrue.)

How habits are formed and broken has been studied by both psychologists and neurobiologists. The neurobiologists study the brains of rats and monkeys, while the psychologists study the behavior of people. They approach the problem from opposite directions, and yet their findings converge.

There are many researchers in this field, but a few names appear again and again. Psychologists David Neal and Wendy Wood did many studies on habit when they were at Duke University, and later the University of Southern California. I’ll discuss their illuminating popcorn study in Part 2 of this series. (Many thanks to David Neal for sending me several helpful articles.) Neurobiologist Ann Graybiel at MIT has done pioneering work on how habits are stored in the brain. It turns out to be the same part of the brain where addictions are formed. Are addictions just habits gone awry?

How Habits Are Formed

To understand how habits are formed, it helps to understand why the brain is capable of habit learning in the first place.As Graybiel discovered, there’s a special place in the brain for habit learning. We’re designed to form habits. Habits are a skill, and it’s a skill that we use. Neal and Wood found that 45% of what we do in a day is habit – automatic, with minimal thought and no particular intention. This is not the "mindful living" ideal of the Zen Buddhists, but it’s an efficient use of brain power. It allows us to do one thing automatically while we think about something else. You can drive a familiar route while planning the speech you’ll make when you arrive because habit learning handles navigation. Without habits, you’d get a lot less done in your day. Habits can serve us, but they also can get in our way.

Habits are overlearned behaviors, repeated and rewarded in the same context many times. Only after many rewarded repetitions will activation shift from the part of the brain where regular learning is stored to where habit learning is stored. The context in which the behavior is performed is part of what’s stored in habit memory. Over time, you learn to associate the context with the behavior. When the behavior (the "routine") becomes a habit, the context becomes a cue for the routine.

The reward is needed to create the habit, but not to maintain it. Once the habit is formed, the reward can be reduced, or even removed for periods of time, and the habit will persist. Habits are learned very slowly, and broken very slowly. They are not goal-directed, or affected by shifting goal states. A habit is a way of dealing with the world that is automated and rigid, and may become less rewarding over time. But as long as it’s working at all, it tends to persist because it’s easy and effortless. Often people go to the same places and do the same things each day, not because they like them so much, but because it’s easier than figuring out what else to do.

Once a habit is learned, it’s never completely unlearned. There are ways to break a habit, but it will reassert itself if you don’t stay vigilant. Habit learning appears to stay in your brain forever, just waiting to be cued.

Emotional Eating versus Habit Eating

Some non-hunger eating is emotional eating, and some is habit eating. It can be tricky to tell the difference. Not knowing why you’re eating doesn’t mean it’s habit eating. It could just as easily mean you’re not in touch with your emotions since that’s the nature of emotional eating. Emotional eaters often don’t know why they’re eating – at least not initially.

People think of emotional eating as comfort eating, but this is not actually its main purpose. The primary purpose of emotional eating is to distract from disturbing thoughts or feelings that you don’t want to allow into your conscious mind. Things like guilt, shame, fear, anger, marital problems – things that disturb you so much that you’d rather worry about being fat. And so you do. Eating is the world’s best distraction since it works on multiple levels. First there is the sensory stimulation – it tastes good. Then there is the obsession. You spend so much time thinking about what you’re going to eat (or not eat), that you hardly have time to think about anything else. And then there is the self-flagellation after eating. If you have any mental energy left over, it’s taken up by feeling fat.

The Normal Eating method (described in my book, Normal Eating for Normal Weight), is designed to ferret out the uncomfortable thoughts and feelings that your mind is working so hard to push down with food. Once you’ve been able to work through them, perhaps with the help of one-on-one counseling, they no longer trigger a desire to eat. Going forward, uncomfortable thoughts and feelings may still occasionally trigger an initial desire to eat (habits are habits), but you’ll know what to do. You’ll know how to figure out what’s really bothering you and address it directly.

So how do you know if it’s emotional eating or habit eating?

• Emotional eating is intentional and random. You are eating in response to a craving. It’s internally motivated and doesn’t depend on context.
• Habit eating is automatic and repetitive. You are eating in response to context and environment. It’s externally cued and depends on context.

Note that you can respond to an emotional eating urge by engaging in habit eating. You can do both at once! If you have a huge fight with your boyfriend then settle down in front of the TV with a pint of ice cream, you’re probably doing both at once.

Sometimes, it’s just habit eating – something you always do in a particular context. The contexts that most frequently cue a habit are location, time of day, preceeding action, and other people. A location cue could be a movie theatre, in front of the television, or anyplace you always (or almost always) eat regardless of hunger. Time of day can cue a habitual snack. Even meal times can cue habit eating if you’ve been snacking and aren’t hungry. An example of "preceding action" as a cue is coming home. Many people head for the refrigerator when they first come home from work or school. People also can cue habit eating. Did you ever have an eating buddy – someone with whom you enjoyed indulging? A 2010 study at Harvard found that the more obese friends you have, the more likely you are to be obese. Perhaps obese people cue habit eating in others (and each other).

Tip: To identify habit eating, look for patterns and repetition. Do you always eat in the same place, at the same time, after doing the same thing, or with the same people? If so, suspect habit eating. But there may be an emotional component, too!

Many studies have been done on how to break bad habits. It’s not easy. The next post in this series will describe three strategies that have been proven to work.

Thoughts? Comments? I’d love to hear them.

Everybody feels passing loneliness now and then, but that’s not the kind of loneliness that people eat over. The kind of loneliness that you eat over is the aching kind that feels never-ending, and grows out of another problem that needs solving. Sometimes loneliness is situational – for example, moving to a new place. But if you’ve had plenty of time to develop social contacts and you’re still lonely, you’re "chronically lonely". That’s the hardest type of all, and the subject of this article.

Why do chronically lonely people often feel lonely even when they’re with other people? Why do they often resist spending time with others? Why do they often find it so unbearable to be home alone in the evening? And what is the solution?

The Problem of Not Liking Yourself

When you’re chronically lonely, just being around other people doesn’t fix it. You can be married and lonely; you can be lonely in a crowd. If you’re chronically lonely, what you lack is authentic connections with other human beings, and generally that’s because you block these connections by not sharing your authentic self. Why?

People who are chronically lonely almost always have as a core problem that they don’t like themselves very much. The give-away is that they generally find it almost unbearable to be alone – especially at night when the distractions of the day are over and it’s quiet. They may even dread turning off the light to go to sleep at night, and procrastinate on that.

Chronically lonely people often have an almost phobic reaction to being by themselves. It feels like falling down a black hole – an awful "dust in the wind" feeling of utter emptiness and alienation from everything and everyone, as though you’re the only person on the planet. If you live alone, you probably avoid going home at night because you can’t bear to be home alone with that feeling. You call it loneliness, but it’s really something else. It’s the horrors; it’s existential alienation. The Big Empty.

Quiet evenings alone are often when emotional eaters binge, perhaps numbing out in front of the TV. They may stay awake until so late that they practically drop from exhaustion, or they may use alcohol to go to sleep so they don’t have to experience their own thoughts lying in bed in the dark.

What is this about? If you can’t bear to be by yourself, it essentially means you can’t bear yourself – you can’t bear your own company, you can’t bear the experience of being "you". That is a huge problem, and it’s also a big block to developing healthy relationships. That’s why it goes along with loneliness and people call it loneliness, but it’s not exactly the same as loneliness.

You can’t stand your own company without distractions because you don’t like yourself. And because you don’t like yourself, you assume no one else will like you either, causing you to shun social contact, making you lonely.

Here’s the good part. I can tell you this for sure. That awful feeling you have about yourself? That horrible feeling that you are flawed and not the same as everyone else? It’s just a feeling. It’s not reality. You are fine! There is nothing wrong with you.

I have worked with many clients, both in the Normal Eating Support Forum and private one-on-one sessions. I’ve known many people who feel worthless, but not one of them ever was worthless – never. They were all beautiful people who were sadly mistaken in their assessment of themselves. The three reasons I see over and over again for serious self-esteem problems are:

• parental neglect or abuse (sometimes not recognized for what it is)
• childhood bullying (most commonly during middle school, ages 12-14)
• growing up gay (because of cultural prejudice)

What these situations (and others like them) have in common is that an innocent child is being told repeatedly that they are wrong or worthless at a time when they do not have the emotional resources to argue with the verdict. That damages self-esteem, but it does not make it true! As an adult you need to recognize this and argue with these old tapes.

You Need Authentic Human Connection

Just being in the proximity of other humans does not cure loneliness. Married people can be lonely. Going to bars and engaging in superficial chit-chat doesn’t cure loneliness. Picking up strangers for sex doesn’t cure loneliness.

The only thing that cures loneliness is authentic human connection. That means allowing another to see you for who you really are and experiencing their acceptance, and seeing another for who they really are and accepting them.

If you don’t like yourself much, it can be scary to let others see the real you. Your impulse will be to hide your real thoughts and feelings under the mistaken notion that the real you is unacceptable and will be rejected. But you’ve got to get past this and take the risk because if you never let anyone see you, you will stay lonely.

That’s not to say you should wear your heart on your sleeve and open up to everyone you meet. Part of good self-care is exercising good judgment and keeping yourself safe. Test the waters with people – make sure they can be trusted with your vulnerable inner self before you reveal too much. Share a little and see what they do with it before sharing more.

One very safe place you can start is the Normal Eating Support Forum. The forum is unique – truly the best support forum on the internet. There is no flaming of any kind, and not a lot of shallow chit-chat or off-topic posts, as in most forums. People talk from the heart about deep personal issues. You can be authentic here, and you can connect. Plus I moderate the forum so you’ll find some good recovery from emotional eating. It’s not just a lot of whining; people make progress. Unlike the blog, the forum is private. Only members have access, and the forum is blocked from all search engines; nothing you type will ever appear in an internet search.

12-step groups are another safe source of support. People are most familiar with AA and NA for alcohol and drug addiction, but there is also a 12-step group for dysfunctional interpersonal relationships such as CoDA, Al-Anon, and SLAA, to name just three. 12-step groups have rules against cross-talk (commenting on what someone else says) and personal attack.

Other types of organizations and groups may offer safe forms of authentic human contact as well. Explore what’s available in your area. The important point is this: Just signing up for activities will not do it. To break through loneliness you need to find places where you can have real heart-to-heart conversations with people who can hear you, understand you, and support you. They do exist!

Have you experienced the kind of chronic loneliness I describe here? Please share your experiences. I’d love to hear from you.

• You barely taste your food or experience having eaten it, and thus need more to feel satisfied.
• Your body doesn’t have time to give you physical cues of satiation, so you eat painfully past full.
• Insufficient chewing causes problems with digestion that are uncomfortable and potentially dangerous.

Slowing down is desirable, but the tricks people use to do this – eat with the opposite hand, count your chews, or (most bizarre) use an iPhone app that rings a bell when you’re allowed to take the next bite – are as “tail wagging the dog” and doomed to failure as dieting to control emotional eating.

If you want to stop emotional eating, you need to understand why you’re doing it and address the underlying issues. If you want to stop fast eating, you need to understand why you’re doing it and address those issues. So why do you do eat so fast?

Why Do You Eat So Fast?

There’s been a lot of discussion about fast eating in the Normal Eating Support Forum. Here are some of reasons members give for fast eating:

“I eat fast, sometimes it’s because my kids are screaming for attention so I shovel it in and carry on but mostly even when I have no distractions I eat fast. I find it hard enough to eat without reading something let alone savour every bite…”

“I was raised in a house where you ate now and tasted it later. Food was not savored (the oldest of us played football and wrestled and could eat an entire box of cereal for breakfast and have room leftover). For me, fast eating is about tucking away the treat that won’t be there because… because. Hmm. Why won’t it be there? I don’t live with my brother any more.”

“I always ate faster than my mom and would get so mad at her because she ate soooo slow and then had to finish her tea and smoke her cigarette before we could leave a restaurant. I rush my kids to hurry up too which is not a good habit to instill in them. I am type A and always in a hurry. I really want to be a calm, moderate sensible person but I am uncomfortable when everything is calm (as much as I want that!).”

“DH called while I was eating. He is on his way home. I suddenly had the urge to finish. Almost like I was in a panic that he would know how late I ate lunch. As if it matters to him.” (Notice the guilt in this quote – more on this in a bit.)

All these descriptions share the themes of anxiety and guilt. Something about eating slowly and mindfully makes these fast eaters feel anxious, guilty, or both. Feelings of anxiety and guilt interfere with the ability to mindfully enjoy the food.

Anxiety and Guilt About Eating

If you want to know what your particular guilt and anxiety in eating is about, the best way to discover this is to eat very slowly for as long as you can bear to do it, and monitor your feelings. What are you thinking about? For example:

• If you’re worried about getting stuff done, then you have a self-care issue. You don’t take time for yourself.
• If you’re worried about someone “catching you” eating – even if this is irrational – then you have guilt about eating.

It’s very common for people to feel guilt about savoring their food – especially if they’re overweight. Often people who are overweight don’t feel they have the right to eat at all, let alone enjoy what they eat.

The guilt is compounded by our culture’s puritanical attitudes towards any sensual enjoyment – the idea that truly high-minded people eat only to fuel their bodies and don’t really enjoy it. The sensual enjoyment of food is considered vaguely obscene. This attitude is not dissimilar to our culture’s attitude towards sex.

So one thing that may help in slowing down is to remind yourself of these two points:

• You have the right to take time for self-care and enjoyment – you don’t have to be productive every waking minute, nor should you be.
• You have the right to savor and enjoy delicious food in all its sensual glory, no matter what your current weight.

But counteracting these negatives just clears the blocks to eating slowly – it doesn’t get you to actually do it. What gets you to actually do it is to focus on the positives, the payoffs.

Slow Eating is a Means, Not an End

I’m a slow eater, and have been for as long as I can remember. But I don’t do it because I read somewhere that I should. I do it because that’s how I enjoy eating. If I eat fast, I get a stomach ache because I can’t chew the food well enough and it sits in my stomach like a lump. Plus I can’t tell when I’m satiated so I overshoot and eat past full, and I hate that feeling. Worst of all, I miss the enjoyment – I don’t get to savor the food as it goes down. Basically, fast eating makes for a much less pleasant eating experience. I want to enjoy my food, not inhale it and end up with a stomach ache.

Though I make no effort to eat slowly, I’m always the last one to finish when I eat with others. In fact, I try to speed up when I’m with others who have finished eating and the entire table is staring impatiently at me. There’s no effort in slow eating for me because it’s the direction of pleasure. I don’t experience any anxiety or guilt when I eat slowly and mindfully, and I’m very attuned to the benefits of slow eating.

In other words, the reason to eat slowly isn’t to eat slowly. It’s not an end in itself that you can achieve through artificial, mechanical tricks. The reason to eat slowly is as a means for savoring your food, making sure your gut feels good as the food goes down, and being in tune with your body’s satiation signals so you don’t inflict pain on your body by overeating. These benefits require mindfulness – paying attention to the taste of your food, the feeling of the food in your gut, and your body’s satiation signals.

If you are busy counting your bites, struggling with a fork in your opposite hand, or listening for an iPhone ding to tell you when to take the next bite, you can’t enjoy your food. How can you pay attention to your eating experience at all with these mechanical distractions to slow yourself down? It’s like trying to eat normally through the artifice of a weight loss diet. It might work temporarily, but eventually it’s just too annoying to sustain.

If you want to sustain a new behavior over the long term, it has to be intrinsically pleasurable. That’s why diets don’t work. And that’s why you need to find the joy in slow eating.

Slow Eating, the Natural Way: Try This!

These mechanical tricks to eat slowly don’t work over the long term any better than a diet, but here’s a suggestion that two forum members found that does work. Pretend you are a restaurant critic and will be called upon to review the food you are eating. Ask yourself, “How does this taste?” Just that will help, but then you may want to go even further. From a forum member:

As noted, asking yourself “how does this taste?” helps. It has helped me slow down somewhat to eat with the intention of reporting on the flavors, textures, and experiences as specifically as possible afterward. Sometimes I try to approach it a little like a food critic (e.g., “Cherries were crisp, but not as tart as expected; maybe going out of season. Flavor was a good counterpoint to crackers, which were flour-y and nicely bland.”).

First clear the way for enjoyment by working on any anxiety and guilt that comes up when you slow down. Once you’ve done this, focusing on the “How does it taste?” question is a good way to put you in touch with the pleasure side of the equation.

Please post your thoughts and experiences. I’d love to hear from you!